Form I-918 02/07/17 N
Page 4 of 11
Received a suspended sentence, been placed on probation,
or been paroled?
1.f.
Yes No
Part 3. Processing Information (continued)
Outcome or disposition (for example, no charges filed,
charges dismissed, jail, probation)
Where were you arrested, cited, detained, or charged?
2.c.
2.f.
Country
2.d.
City or Town
2.e.
State
Why were you arrested, cited, detained, or charged?2.a
Date of arrest, citation, detention, or charge (mm/dd/yyyy)2.b.
Information About Arrests, Citations, Detentions, or Charges
Exercised diplomatic immunity to avoid prosecution for a
criminal offense in the United States?
1.i.
Yes No
Been in jail or prison?
Been the beneficiary of a pardon, amnesty, rehabilitation,
or other act of clemency or similar action?
1.g.
1.h.
Yes No
Yes No
Outcome or disposition (for example, no charges filed,
charges dismissed, jail, probation)
Why were you arrested, cited, detained, or charged?
Where were you arrested, cited, detained, or charged?
3.a
3.c.
Date of arrest, citation, detention, or charge (mm/dd/yyyy)3.b.
3.f.
Country
3.d.
City or Town
3.e.
State
4.d. Illicitly trafficked in any controlled substance or knowingly
assisted, abetted, or colluded in the illicit trafficking of any
controlled substance?
Yes No
4.c. Knowingly encouraged, induced, assisted, abetted, or
aided any alien to try to enter the United States illegally?
Yes No
4.b. Engaged in any unlawful commercialized vice, including,
but not limited to, illegal gambling?
Yes No
4.a.
Have you EVER:
Engaged in, or do you intend to engage in, prostitution or
procurement of prostitution?
Yes No
Have you EVER committed, planned or prepared, participated
in, threatened to, attempted to, conspired to commit, gathered
information for, or solicited funds for any of the following:
5.a. Hijacking or sabotage of any conveyance (including an
aircraft, vessel, or vehicle)?
Yes No
5.b. Seizing or detaining, and threatening to kill, injure, or
continue to detain, another individual in order to compel a
third person (including a governmental organization) to
do or abstain from doing any act as an explicit or implicit
condition for the release of the individual seized or
detained?
Yes No
The use of any firearm with intent to endanger, directly or
indirectly, the safety of one or more individuals or to
cause substantial damage to property?
5.d.
Yes No
Assassination?5.c.
Yes No
The use of any biological agent, chemical agent, nuclear
weapon or device, explosive, or other weapon or
dangerous device, with intent to endanger, directly or
indirectly, the safety of one or more individuals or to
cause substantial damage to property?
5.e.
Yes No
Have you EVER been a member of, solicited money or members
for, provided support for, attended military training (as defined in
section 2339D(c)(1) of Title 18, United States Code) by or on
behalf of, or been associated with any other group of two or
more individuals, whether organized or not, which has been
designated as, or has engaged in or has a subgroup which has
been designated as, or has engaged in:
A terrorist organization under section 219 of the INA?
6.a.
Yes No
Hijacking or sabotage of any conveyance (including an
aircraft, vessel, or vehicle)?
6.b.
Yes
No
If you answered “Yes” to any of the above questions, respond to
the questions below to provide additional details. If you need
extra space, use the space provided in Part 8. Additional
Information.